腹腔镜手术联合透明质酸钠在粘连性肠梗阻中的综合应用价值

Comprehensive application value of laparoscopic surgery combined with sodium hyaluronate in adhesive intestinal ileus

目的观察腹腔镜手术联合透明质酸钠治疗粘连性肠梗阻的疗效及其对疾病相关指标的影响。方法选取2010年9月～2014年4月期间于安吉县人民医院治疗的180例粘连性肠梗阻患者,随机分为对照组和观察组2组,每组各90例,对照组采用开腹手术治疗,观察组则采用腹腔镜手术联合透明质酸钠治疗。比较2组间手术时间、术中出血量、术后胃肠道功能恢复时间、住院时间以及并发症发生情况等手术相关指标差异,比较术前及术后1 w、4 w血清中胃肠激素胃泌素（gastrin,GAS）、胃动素（motilin,MTL）、胆囊收缩素（cholecystokinin,CCK）和生长抑素（somatostatin,SS）水平差异,炎症细胞因子超敏热休克蛋白（hs-CRP）、白介素-2（IL-2）、白介素-6（IL-6）、白介素-10（IL-10）及肿瘤坏死因子-α（TNF-α）水平差异。结果观察组术中出血量显著少于对照组,胃肠道功能恢复时间及住院时间显著短于对照组,并发症发生率显著低于对照组,差异有统计学意义（P〈0.05）。术后1、4 w,观察组患者GAS、MTL、SS水平显著高于对照组,CCK水平显著低于对照组,差异有统计学意义（P〈0.05）。术后1、4 w,观察组患者hs-CRP、IL-2、IL-6、TNF-α水平显著低于对照组,差异有统计学意义（P〈0.05）。结论与传统开腹手术相比,采用腹腔镜联合透明质酸钠治疗粘连性肠梗阻具有对患者消化功能影响小、术后炎症反应小的优点,从而有利于缩短患者术后的康复时间并抑制再发肠梗阻等并发症的发生。

Objective To observe the efficacy of laparoscopic surgery combined with sodium hyaluronate in the treatment of adhesive intestinal obstruction and its influence on disease-related indexes.Methods 180 cases of patients with adhesive ileus from September 2010 to April 2014 were selected and randomly divided into control group and observation group two groups,90 cases in each group.The control group was treated with laparotomy and the observation group was treated by laparoscopic surgery combined with sodium hyaluronate.Then the operation related indexes such as operation time,intraoperative bleeding volume,postoperative gastrointestinal function recovery time,hospitalization time and complications of two groups were compared.And the serum levels of gastrointestinal hormone such as GAS,MTL,CCK and SS and inflammatory cytokines such as hs-CRP,IL-2,IL-6,IL-10 and TNF-α of two groups before and after treatment were detected and compared.Results The intraoperative bleeding volume of observation group was less than control group,postoperative gastrointestinal function recovery time and hospitalization time were shorter than control group,the incidence of complications was lower than control group,the difference was statistically significant（P〈0.05）.1,4 weeks postoperative,the serum levels of gastrointestinal hormone such as GAS,MTL and SS of observation group were higher than control group,while the CCK was lower than control group,the difference was statistically significant（P〈0.05）.1,4 weeks postoperative,the serum levels of inflammatory cytokines such as hs-CRP,IL-2,IL-6 and TNF-α of observation group were lower than control group,the difference was statistically significant（P〈0.05）.Conclusion Compared with the traditional laparotomy,laparoscopy combined with sodium hyaluronate has the advantages of small effect on patients with digestive function and postoperative inflammatory reaction,thus helps to shorten the recovery time of patients after surgery and inhibition the occurrence of complications such as recurrent intestinal obstruction.